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 View the PDF transcript for Critical Access Hospital Case Study: Mayers Memorial Hospital

Complete a detailed case study analysis of the given case, using the process analyzing Strategic Health Care Cases  Strategic Management of Health Care Organizations.

Your completed case study analysis report will include the following sections:

  • Executive summary
  • Key issues
  • Situational analysis
  • Strategy formulation
  • Recommendation
  • Implementation strategies
  • Benchmarks for success and contingency plans

 cite your sources in your work and provide references for the citations in APA format.

Your assignment should be addressed in an 8- to 10-page document.

Submission Details:

  • Support your responses with examples.
  • Cite any sources in APA format..

C A L
I F O

R N I
A F L E X P R O G R A M

Critical Access
Hospital Case Study
MAYERS MEMORIAL HOSPITAL

S E P T E M B E R 2 0 1 2

Fall River Mills, CA

Is the Medicare Rural Hospital Flexibility (Flex) Program and small rural hospitals’ conversion
to Critical Access Hospital (CAH) status improving the quality of care and performance while
enhancing local emergency medical services? A case study highlighting Mayers Memorial Hospital,
Fall River Mills, California, was conducted as part of California’s Medicare Rural Hospital
Flexibility (Flex) Program in order to examine and report on these questions.

C A S E S T U D Y O B J E C T I V E S
A N D M E T H O D S
The Mayers Memorial Hospital case study was completed to identify
changes to the community, hospital, and other aspects of health care,
that have occurred due to the hospital’s conversion to Critical Access
Hospital (CAH) status and its involvement in the Flex Program.
The study also aims to identify needs and issues for Flex Program
planning purposes. To accomplish this, the following occurred:

• Local health services and community background
information were collected from April to May 2012 on
Fall River Mills, California and the surrounding area.

• Interviews of hospital staff, hospital board members, and local
emergency medical services (EMS) personnel were conducted
in Fall River Mills April 23 and 24, 2012.

• A survey of health care providers (e.g., physicians, physician
assistants, nurse practitioners, nurse anesthetists) working at
Mayers Memorial Hospital was conducted April – May 2012.
The survey response rate was 22 percent.1

• A community focus group was conducted in Falls River Mills
on April 23, 2012.

Twenty-eight individuals from the hospital service area were included
in the case study process.

The California Department of Health Services, State Office of
Rural Health, administers the Flex Program in California and was
the sponsor of the case study. Rural Health Solutions, Woodbury,
Minnesota conducted the case study and prepared this report.

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1 Health care providers working less than 2 days per month at
Mayers Memorial Hospital were not included in the survey.

F A L L R I V E R M I L L S , C A L I F O R N I A
A N D T H E S U R R O U N D I N G A R E A 2

The town of Fall River Mills is located in Northeastern California and is
served by State Highway 299, the major route running east to west across
northern California. Named to commemorate the many mills in town,
Fall River Mills is located between the Sierra Nevada and Cascade Mountain
ranges and is surrounded by mountains in all four cardinal directions.
Fall River Mills is a town that enjoys a fascinating history, complete with
entrepreneurial adventurers, treacherous travels through the valley, and
conflicts between Native American and Caucasian settlers, and while the
first settlers in the 1850’s and 60’s may have come to seek their fortunes
in timber milling, residents today are more interested in the wealth of
the local landscape. Surrounded by pristine rivers, mountains, lakes, and
waterfalls, the area attracts more tourists than lumberjacks.

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This area is home to the Achomawi or Pit River Tribe, which has a
long history in the area and makes up 0.5 percent of the population.
The Achomawi first occupied Fall River Mills when two Caucasian
men named Mr. Bowles and Mr. Rogers first attempted to settle in the
area in 1855. As Caucasian settlers began building flour and timber
mills and establishing a ferry service, their relationship with the
Achomawi was, unfortunately, violent and even deadly. Eventually,
the federal government saw the need to protect settlers, and the Army
Department of the Pacific established a garrison there for that purpose.

With the garrison established, settlers continued to capitalize on
the local natural resources. In 1920, developers in Fall River Mills
embarked on an effort to establish the largest Hydroelectric Power
Plant system in California’s Northeast Wilderness. They also changed
the name of the town from Falls City to Fall River Mills in honor
of the many mills in town. The tallest mill, The Fall River Feed Mill,
stood four stories high and was destroyed by a fire on June 13th, 2003.

Milling continues in the area today, as does agriculture, consisting
mainly of wild rice, garlic, mint, hay, lavender, alfalfa, and cattle
ranching. Tourism also keeps Fall River Mills on the map, with its
wealth of lakes, rivers, mountains, and highly acclaimed golf course.
Major employers of the area include Mayers Memorial Hospital
and Fall River School District.

2 http://en.wikipedia.org/wiki/Fall_River_Mills,_California

“ You get up and look at the mountains; they
are such an asset and
you can’t put a
value on them.”C a s e S t u d y Pa r t i c i p a n t

Fall River Mills is situated in the Intermountain Area in Shasta County.
Fall River, Tule River, Ja-She Creek, Lava Creek, Bear Creek, Shelly Creek
and Pit River lie close by and make fishing, boating, canoeing, and water
activities a popular pursuit. The Intermountain Area is home to several
lakes, including Fall River Lake, Eastman Lake, Lake Britton and Big Lake.
Fall River Mills also hosts the annual Fall River Century Bike Ride each
spring. Hundreds of cyclists participate in this exciting event.

Burney, California, the largest city (population 3,124) in Mayers Memorial
Hospital’s service area, is 16 miles southwest of Fall River Mills and
50 miles north of Redding.3 It too is known for its natural beauty and
outdoor recreational opportunities: McArthur-Burney Falls Memorial
State Park, Burney Falls, fly fishing, skiing, hiking, and many others.

Shasta County is approximately 3,775 square miles with a population of
177,223, or 46.9 persons per square mile. Redding, California, makes up
over half of the County’s population but only 1.6 percent of the land.
Without Redding, the County’s population density is 23.5 persons per
square mile. Shasta County’s population increased 8.6 percent from 2000
to 2010, as compared to the state which experienced 10.0 percent growth
during that same time period. Compared to the state as a whole, Shasta
County’s population is more likely to be older (16.9 percent of the pop-
ulation is 65 years and older), white and non-Hispanic, English speaking,
living below poverty, and high school graduates. The median household
income for 2006-2010 was $43,944, compared to $60,883 for the state
of California. In 2010, the population of Fall River Mills was 573.4

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3 www.census.gov

4 www.census.gov, http://quickfacts.
census.gov/qfd/states/06/06089/html

When asked, “What makes Fall River Mills and the surrounding area a healthy place to live?”, case study
participants report the following: beautiful environment/scenery, limited/no stress, farming and ranching, clean air, outdoor
recreational opportunities (e.g., biking, kayaking, hiking, golfing), good health care providers, support from local businesses
and schools, limited access to fast food, low population density, no traffic, and hard working and physically active people.

When asked, “What makes Fall River Mills and the surrounding area an unhealthy place to live?”, case
study participants report the following: uninsured population that frequently delays preventative health care services, lower
income, limited employment opportunities for young people, lack of parenting/sex education opportunities, lack of housing,
extreme weather conditions, agricultural chemicals and equipment, drive time/distance to some conveniences, lack of some
essential health services such as mammography and MRI, limited/few specialty health care services, limited number of primary
care physicians, air quality due to smoke from wood burning stoves and dust, poor/limited educational opportunities, no
gyms/indoor fitness opportunities, high rate of substance abuse, and a lack of public transportation.

“ The weather can be detrimental at times because we cannot get over the mountain.”C a s e S t u d y Pa r t i c i p a n t

Mayers Memorial Hospital Vision:

“To become the provider of first
choice for our community by being
a leader in rural healthcare.”

Mayers Memorial Hospital
Mission Statement:

“Mayers Memorial Hospital
District serves the Intermountain
area providing outstanding
patient-centered healthcare to
improve quality of life through
dedicated, compassionate staff
and innovative technology.”

M A Y E R S M E M O R I A L H O S P I T A L

Mayers Memorial Hospital (aka Mayers Memorial Hospital
District) was built in 1956 through donations from the
community. The hospital is named after Doctor Mayers and
his wife who worked in the community, started the campaign
to raise funds to build the hospital but then were tragically
killed in an automobile accident.5 Mayers Memorial Hospital
converted to CAH status November 1, 2001, making it the
7th CAH in California, and the 484th CAH in the U.S.6

Mayers Memorial Hospital is part of a hospital district that
offers a 22-bed hospital (10 beds staffed, 22 beds certified);
level IV trauma, emergency, ambulance, inpatient, outpatient,
hospice, and obstetric services; and two 24-hour skilled/long-
term care nursing facilities (SNF). One 50-bed long-term
care facility is attached to the hospital while the other 49-bed
facility is located in Burney (16 miles from Fall River Mills).
The Burney site includes a 21-bed Alzheimer’s Dementia
care unit. While not a part of the hospital and its operations,
Mountain Valley Health Centers is a federally qualified health
center (FQHC) that operates adjacent to the hospital campus.

The hospital employs approximately 220 people (200 full-time
equivalent – FTE – employees). The Chief Executive Officer
has been working in the hospital for 2 years, the Chief Clinical
Officer for 13 years, the Acute Care Chief Nursing Officer/
Quality Improvement Coordinator for 22 years, the SNF Chief
Nursing Officer for 16 years, Human Resources Director for
8 years, and the Controller for 28 years. In addition, there are
18 healthcare providers (physicians and specialists) who work
in the hospital at least 2 days per month; however, none are
employed by the hospital. Health care providers surveyed
report they have worked an average of 8 years at the hospital.

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5 http://www.mayersmemorial.com/ourhistory
6 As of June 30, 2012 there are 31 CAHs in California and 1327
in the U.S., 15 hospitals converted to CAH status on November 1,
2001. Source: Flex Program Monitoring Team. www.flexmonitoring.org

Mayers Memorial Hospital’s service area includes the
communities of Fall River Mills, Burney, Adin, Bieber,
Nubieber, McArthur, Glenburn, Hat Creek, Cassel,
Old Station, and Johnson Park. This service area has
a population of approximately 10,000 full-time residents.
The hospital’s 2011 average daily census for acute/OB
inpatients was 2.36 patients, 1.59 for swing bed patients,
and 76.64 for long term care residents. The hospital had
3,015 emergency room (ER) visits and provided 1,041 out-
patient services, 8,331 laboratory visits, and 3,581 radiology
procedures that same year. The nearest hospital to Mayers
Memorial Hospital is Mercy Medical Center Mount Shasta
(also a CAH) in Mount Shasta, California, 60 miles north
of Fall River Mills. The nearest tertiary center is located
70 miles southwest (or 1.25 hours by road) of Fall River
Mills in Redding, California.

While Mayers Memorial Hospital patients are referred and
transferred to a number of tertiary centers, most are trans-
ferred to hospitals in Redding, California, the University
of California Davis, or the University of California, San
Francisco (both universities are over 230 miles by road).
There are no level I trauma centers within 230 miles of
Fall River Mills, with the closest in Sacramento, California.

Ambulance services for the area are based out of the Mayers
Memorial Hospital. Its service area is approximately one
hour in any direction and is operated by teams of paramedics
(3 full-time, 3 as needed) and Emergency Medical Technicians
(EMTs – 2 full-time, 2 part-time, and 2 as needed). For the past
several years, Mayers Memorial Hospital’s EMS squad has had
approximately 250 ambulance runs and 85 transports per year.
The Burney Fire Protection District and Modoc Medical
Center also provide ambulance services for the area.

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I M P A C T O F T H E F L E X P R O G R A M

The national Medicare Rural Hospital Flexibility (Flex) Program
was created as part of the federal Balanced Budget Act of 1997.
Its goals are to:

1) Convert small rural hospitals to CAH status

2) Improve CAH performance

3) Improve the quality of patient care in CAHs

4) Develop local systems of care through
emergency medical services (EMS)
integration and community engagement

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Mayers Memorial Hospital was selected for an impact analysis
using a case study approach to examine Flex Program outcomes
and the impact that CAH conversion has had on the hospital
and the community it serves. Data were obtained from the
California Department of Health Services, State Office of
Rural Health and the national Flex Monitoring Team, as well
as case study participants. Case study participants were asked
questions related to each of the Flex Program goals, focusing
on outcomes, accomplishments, needs, and challenges. Below
is a report for each goal, including: goal status, indicators for
success, and indicators of ongoing needs and challenges. Although
many of the indicators cannot be directly and/or purely attributed
to the activities of the California Flex Program, case study
participants familiar with the Flex Program report that without
it, many accomplishments would have been difficult, delayed,
and/or not pursued.

Goal: C O N V E R T H O S P I T A L S T O C A H S T A T U S
Status: A C C O M P L I S H E D

I N D I C A T O R S O F O U T C O M E S A C H I E V E D :
• Mayers Memorial Hospital was designated a CAH on
November 1, 2001.

• It took the hospital approximately 2 years to explore
the CAH conversion option, complete a financial
feasibility study, work with the Flex Program to
prepare for and complete the CAH application
process, and be surveyed and licensed as a CAH.

• Hospital staff report they received CAH conversion
assistance from California Hospital Association and
California Flex Program staff.

• All hospital staff interviewed report they support the
hospital’s conversion to CAH status.

• Hospital staff report conversion to CAH status was
a “good” decision as it has improved the hospital’s
reimbursement and provided them other support
through networking, education, sharing of policies
and procedures, and other technical assistance.

• All health care providers report they are aware the
hospital is a CAH and report it has had an impact on
the hospital’s long term viability.

• Several case study participants report Mayers Memorial
Hospital is one of the reasons they moved to the area.

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“ We [hospital] have to be here. People’s lives
depend on it.

“ CAH status opens a lot of access to resources and not
just reimbursement but also
education and networking
and all of that helps us
provide better care.”C a s e S t u d y Pa r t i c i p a n t

”C a s e S t u d y Pa r t i c i p a n t

“ Our hospital could not survive without CAH status;
75% of the patients are
Medicare or Medicaid.”C a s e S t u d y Pa r t i c i p a n t

Goal: P E R F O R M A N C E I M P R OV E M E N T
Status: O U T C O M E S A C H I E V E D / O N – G O I N G N E E D S

I N D I C A T O R S O F O U T C O M E S A C H I E V E D :
• Case study participants Mayers Memorial Hospital
District’s performance has improved due to changes
in organization leadership and its renewed focus on
finances and the community.

• Case study participants report the hospital’s greatest
performance achievements over the past 5 years as: staying
open, avoiding bankruptcy, having a clean financial audit
in 2011, passing a local bond to support physical plant
improvements, and strategic and master facility planning.

• The hospital used Flex Program funding to support
financial assessments and strategic planning.

• The hospital has made extensive changes to its service
contracts, sold leased equipment, outsourced billing, re-built
relations with vendors and other partners, eliminated some
lines of service, and laid-off employees in order to stabilize
and improve hospital finances.

• The hospital has restructured its financing through an accounts
payable bond and line of credit and negotiated with vendors to
pay off debt. In March 2009, the hospital had $5 million in
accounts payable and in April 2012 it had $850,000.

• The hospital had a $1.1 million operating loss in 2010 and a
$1.1 million gain in 2011.

• The hospital’s staff turnover rate has decreased from
25 percent in 2009 to 17 percent in 2011.

• The hospital established a revenue cycle committee.

• The hospital applied for and received a $2 million loan
from United Health Group for its electronic health record.

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“ I haven’t been excited about our hospital in
long, long time but
things have changed.”C a s e S t u d y Pa r t i c i p a n t

“ It was insane the amount of work we were doing
to get a bill out. Now,
more often than not, we
bill one time versus
multiple times. ”C a s e S t u d y Pa r t i c i p a n t

• The local hospital district passed Measure D (hospital
district bonding bill), only one of two hospital districts
in the state to pass a bonding bill, that supports master
facility planning and facility updates.

• Some hospital staffs have been trained in Lean process
improvement.

• The hospital closed its home health services and discon-
tinued mobile MRI and mammography services either
because of low volumes or financial losses.

• The hospital implemented a pharmacy dispensing system.

• Hospital staffs report they attend the annual Rural Health
Symposium, sponsored by the California Flex Program.
They report the conference supports networking, sharing of
resources and knowledge, and the cultivation of new ideas.

• The hospital offers mental health, dermatology, and endo-
crinology services to patients via telemedicine.

• The hospital is a member of the California Critical Access
Hospital Network (CCAHN).

• Health care providers report their overall view of the
hospital as either “good” or “very good”.

• Health care providers report the greatest accomplishments of the hospital over the past five years as: maintaining
access to emergency care services, staying open, establishing an “excellent” lab, retaining “very strong” and “established”
health care providers, and providing access to a local psychologist.

• Comments by case study participants related to performance improvement successes include:

— “We’re in the best financial position that I have seen in at least 10 years.”

— “Before, all we [hospital] heard from the community were negative things. Now we are hearing a lot of positives.”

— “This is definitely a CAH and a wonderful but challenging place to work. I have respect for colleagues and
co-workers here.”

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P E R F O R M A N C E I M P R OV E M E N T AC H I E V E M E N T S C O N T I N U E D. . .

• Case study participants report the greatest performance
challenges of the hospital as: building a new facility/securing
the funds to build a new facility, family physician and staff
recruitment and retention, billing, fully implementing the
hospital’s electronic health record, training staff, remaining
financially viable, providing specialty care services locally,
building a viable relationship with Mountain Valleys Health
Centers, and staffs’ acceptance of change.

• The hospital does not offer mammography or MRI services.

• The hospital is exploring opening a rural health clinic.

• Although the hospital can offer healthcare services via tele-
medicine, few patients and providers are utilizing this resource.

• The hospital and Mountain Valleys Health Centers do not have
a cohesive working relationship/partnership. The greatest
concerns are the lack of health care providers and the need
for rotating specialists and urgent care services for patients.

• Hospital staff report a need to increase networking between
area health care organizations, such as: other CAHs, long-term
care organizations, Pit River Indian Health Services, and
Mountain Valleys Health Centers.

• Hospital staff report a need for a statewide or regional CAH
focused ICD-10 readiness group and a chief financial officer
user group.

• Hospital staff report a need for additional organization-wide
strategic planning and business planning.

• The hospital has plans to offer additional health services in
Burney and more surgery services in Fall River Mills.

• Case study participants report a need for hospital physical plant
upgrades and general maintenance (e.g., removal of cobwebs
from exterior walls).

• Case study participants report a need for increased community
involvement in the hospital.

• Case study participants report the need for increased access
to health improvement/disease prevention programs/services
and some specialty care services for the community.

• Case study participants report a need to look at alternative care
environments (e.g., assisted living, home care, and visiting nurse
service) for patients.

• Case study participants report a need for geographically
balanced hospital board member representation (e.g., Burney
and Fall River Mills).

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I N D I C A T O R S O F
O N – G O I N G P E R F O R –
M A N C E I M P R O V E M E N T
N E E D S / C H A L L E N G E S :

“ I’m not even sure the community knows the
hospital offers services
through telemedicine.”C a s e S t u d y Pa r t i c i p a n t

“ If there is any building in town that needs to
be painted and clean,
it’s the hospital.”C a s e S t u d y Pa r t i c i p a n t

“ We need to talk to Mountain Valley; we
need to work with them.
They’re important to
us and we’re important
to them. ”C a s e S t u d y Pa r t i c i p a n t

• Case study participants report a need for more
financial/performance networking between CAHs
in California and the region.

• Community members report confusion regarding the
hospital’s discount program for time-of-service payments
made by patients and inconsistent billing practices.

• When asked how the hospital should spend $25,000
in grant funds, case study participants (non-physicians)
report: EMR implementation and training, bariatric
equipment for patients, new beds and lifts, ICD-10
training, documentation training for nurses and
physicians, showers for long-term care residents,
patient and staff safety programs, Trauma Nurse Core
Course training, health fair focused on Hispanics,
and internal staff communications.

• When asked how the hospital should spend $40,000
in grant funds, health care providers report: healthcare
provider recruitment, bonuses for nurses, portable
ultrasound for the emergency room, and enhanced
emergency room facilities.

• Comments by case study participants related to
performance improvement needs/challenges include:

— “Everyone has tried to keep the hospital here [Fall
River Mills]. It’s been a struggle since day one and
it probably always will be.”

— “The hospital needs about $36 million to build
a 35,000 square foot hospital.”

— “There are lots of questions about where to put
a new hospital.”

— “We need to work with Mountain Valleys Health
Centers; there is no question about it.”

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P E R F O R M A N C E I M P R OV E M E N T O N – G O I N G
N E E D S / C H A L L E N G E S C O N T I N U E D. . .

Performance Improvement

HIGHLIGHTS:
Mayers Memorial Hospital has improved many

aspects of its operation and physical plant since

CAH conversion; however, most case study

participants report its change in leadership,

stabilized medical staff, discontinued unprofitable

contracts, and rebuilt vendor relationships as the

changes that have had the biggest impact on

hospital performance.

OUTCOMES: Decreasing accounts receivable

by $4.15 million over a 4-year period, reversing

a $1.1 million operating loss into a $1.1 million

gain in one year, improving its current ratio

from 0.7 to 2.05, and decreasing staff turnover

by 7 percent over a three-year period.

Goal: I M P R OV E T H E Q UA L I T Y O F PA T I E N T C A R E
Status: O U T C O M E S A C H I E V E D / O N – G O I N G N E E D S

I N D I C A T O R S O F O U T C O M E S A C H I E V E D :
• The hospital developed a quality plan and has set up the
structure to focus on key hospital areas (e.g., surgery)
and establish baseline data. The first area of focus will
be congestive heart failure based on CMS’ core measures.

• The hospital has improved quality through:

— Updating hospital protocols, standard orders, and
standards of care.

— Using trauma registry data as part of its quality
improvement process.

— Assigning a staff person to be in charge of hospital
infection control and consequently putting all of
the infection control policies and procedures in place.

— Implementing programs directed to improve patient
safety, organization culture, and customer service.

• Hospital staff report the hospital’s greatest quality
improvement achievement as having no hospital acquired
infections in 2011 and beginning implementation of the
hospital’s electronic health record.

• Case study participants report high satisfaction for the
health care providers serving the area.

• Hospital staff report their involvement with CCAHN,
Bedside Trust, the Rural Health Symposium, and other
Flex Program training and workshops have resulted in
the hospital engaging in quality improvement programs
and adopting change sooner.

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“ I am sure we [hospital] would have made these
quality improvement
changes eventually, it
just would have taken
a lot longer [without
the Flex Program].”C a s e S t u d y Pa r t i c i p a n t

“ The culture of the organ-ization has changed: it is
more patient-centered.”C a s e S t u d y Pa r t i c i p a n t

• The hospital is one of six CAHs in California that is designated as a trauma center (level IV).

• The hospital emergency department, as part of its Level IV trauma center designation, participates in the Sierra
Sacramento Valley (SSV) Local EMS Authority (LEMSA) trauma quality meetings. Their first meeting was held
in February 2012.

• Some hospital staff have been trained in Lean process improvement.

• Long-term care staff participate in monthly training, typically via webinar. Examples of two recent trainings
include one focused on customer service and one specific to Alzheimer’s disease.

• The hospital has added and/or enhanced its lab, respiratory care, CT, wound care, hospice, and general surgery
services since conversion to CAH status.

• The long terms care facilities have a quality reporting system and team. They track falls, skin tears, resident complaints,
urinary tract infections, and other measures and meet monthly to discuss needs, train staff as needed, and change
policies and procedures.

• The long-term care facilities have developed an adopt-a-resident, room program costing $6,000 per room.

• County health status data indicate Shasta County as having improved its ratings for deaths associated with7:

— Diabetes

— Coronary heart disease

— Chronic lower respiratory disease

— Drug-induced deaths

• Comments/information by case study participants related to improvements in quality of care include:

— “We are starting to hear positive comments from patients regarding personal care.”

— “We have had no hospital acquired infections in the past year and patients are even talking about it.”

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“ I’ve been at different hospitals for things but I’ve never had the care like here. They’re just special.”C a s e S t u d y Pa r t i c i p a n t
7 http://www.cdph.ca.gov/pubsforms/Pubs/
OHIRProfiles2011.pdf and http://www.cdph.ca.gov/
programs/ohir/Documents/shasta.xls

Q UA L I T Y O F C A R E I M P R OV E M E N T S C O N T I N U E D. . .

• Hospital staff report a need for more training hospital-wide. They report training assures staff maintain and develop key
skills and improves the overall culture of the organizations.

• The hospital has plans to install, implement, and train staff on an electronic health record by December 2012.

• The hospital has plans to start a pediatric quality improvement program in its emergency department.

• The hospital has had limited participation in Hospital Compare and no participation in QHi7.

• Hospital staff report health care providers are not fully engaged in the hospital’s quality improvement efforts.

• The hospital has no dedicated quality improvement director so follow-up and monitoring of outcome measures is limited.

• No home care services are available in the Mayers Memorial Hospital service area.

• Community members report they seek health services outside of Fall River Mills because of the lack of availability of
some services (MRI, mammography, and naturopathic care), medication and/or clerical errors, high turnover of local
health care providers, and/or billing issues.

• Community members report a need for a “functional” ethics committee at the hospital.

• Case study participants report access issues for seniors, behavioral health services, family planning/outreach,
mammograms, and MRI.

• Case study participants would like to see the hospital district focus on community wellness.

• Health care providers report maintaining momentum towards continuous quality improvement, and recruitment of
a surgeon and orthopedist are the hospital’s greatest quality improvement challenges.

• County health status data indicate Shasta County as having an decreased its ratings for the following death rates8;

— Lung cancer

— Female breast cancer

— Prostate cancer

— Alzheimer’s Disease

• Comments by case study participants related to quality improvement needs/challenges:

— “We need to move from healing to health.”

— “We are pockets of people trying so hard to do everything right but no one is
looking at geography and how to make the people healthier.”

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8 Hospital Compare is a national Medicare quality data bench-
marking tool designed for consumers and health care providers
and QHi is a national quality benchmarking tool designed for
small rural hospitals and used in 16 states, including California.

9 http://www.cdph.ca.gov/pubsforms/Pubs/OHIR
Profiles2011.pdf and http://www.cdph.ca.gov/programs/ohir
/Documents/shasta.xls

— Influenza/pneumonia

— Chronic liver disease and
cirrhosis

— Unintentional injuries

— Suicide

— Homicide

— Firearm related deaths

I N D I C A T O R S O F O N – G O I N G
P A T I E N T C A R E N E E D S / C H A L L E N G E S :

Goal: E M S I N T E G R A T I O N / C O M M U N I T Y E N G A G E M E N T
Status: O U T C O M E S A C H I E V E D / O N – G O I N G N E E D S

I N D I C A T O R S O F O U T C O M E S A C H I E V E D :
• Case study participants report local EMS provides high quality services.

• Local EMS is based in the hospital and is integrated into hospital operations.

• Local EMS changed its Local EMS Authority (LEMSA) from Northern
California EMS (NorCal) to Sierra Sacramento Valley LEMSA (SSVL)
in order to access additional training, attend SSVL LEMSA quarterly
meetings, provide input into LEMSA decision making, and focus more
on quality improvement.

• Local EMS is a paid service staffed with paramedics and EMTs.

• EMS protocols are reviewed semi-annually by EMS staff.

• The hospital, a level IV trauma center, is one of six CAHs designated as a trauma center in California.

• Designation as a level IV trauma center provides the hospital with increased access to training and trauma quality
improvement data and initiatives.

• Local disaster planning has included revising the disaster planning manual; establishing a framework for policies,
procedures, and an emergency management plan; and conducting drills.

• As part of its quality improvement process, local EMS facilitates a bi-monthly run review that includes local EMS,
6 other ambulance providers, and volunteer fire departments. It also facilitates peer chart reviews for all transferred,
codes, and trauma patients.

• The hospital emergency department serves as the area base hospital for any emergency responder that needs support.

• The hospital works with other area health organizations to make EMS training available, including the ambulance service
in Burney and Mercy Medical Center and Shasta Regional Medical Center, both in Redding.

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“ EMS is awesome. I don’t think I have ever heard a
complaint about them.”C a s e S t u d y Pa r t i c i p a n t

“ Disaster planning has come a long way.”C a s e S t u d y Pa r t i c i p a n t

conclusions

• Local EMS operates at a loss and is subsidized through local taxes.

• Health care providers report the area has a high rate of illegal drug
use and over utilization/inappropriate use of the emergency room.

• The hospital is exploring the expansion of the hospital district
which would add to its EMS service area.

• Some area residents are Spanish speaking but not all paramedics
and EMTs speak Spanish.

• Most ambulance run review errors are related to documentation.

• Community members report they do not know which air
ambulance insurance they should purchase and/or the
differences between each of the insurances’ coverage.

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I N D I C A T O R S O F
O N – G O I N G E M S /
C O M M U N I T Y
E N G A G E M E N T
N E E D S / C H A L L E N G E S :

This case study highlights the unique characteristics and environment surrounding Mayers Memorial Hospital, as

well as many of the hospital’s successes and challenges. Successes can be seen through the hospital’s: conversion

to CAH status, financial and operational improvements, partnership with local emergency responders, and changing

hospital culture. Meanwhile, challenges center on local health systems development, addressing the hospital’s

physical plant/building a new hospital, implementing an electronic health record, health promotion, and improving

access to primary and specialty care services. Although Mayers Memorial Hospital has made significant strides since

converting to CAH status, opportunities for additional improvement exist, such as: 1) improving partnerships
with local and regional health services organizations; 2) using telemedicine to improve access
to care; 3) supporting population health improvement; 4) increasing access to primary care
services; 5) increasing staff skills through on and off-site training opportunities; 6) enhancing
both internal and external communications; and 7) implementing, tracking, and reporting
quality and performance outcomes.

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This report was created by Rural Health Solutions,

Woodbury, Minnesota – www.rhsnow.com,

funded by the California Department of Health Services,

State Office of Rural Health, through a grant from the U.S.

Department of Health and Human Services, Health Resources

and Services Administration, Office of Rural Health Policy.

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